Healthcare Provider Details

I. General information

NPI: 1134330970
Provider Name (Legal Business Name): HOLISTIC HEALTH CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 WALKERS MILLS ROAD
BETHEL ME
04217-5905
US

IV. Provider business mailing address

279 WALKERS MILLS ROAD
BETHEL ME
04217-5905
US

V. Phone/Fax

Practice location:
  • Phone: 207-824-8501
  • Fax: 207-824-0975
Mailing address:
  • Phone: 207-824-8501
  • Fax: 207-824-0975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD YASKO
Title or Position: MANAGING MEMBER
Credential:
Phone: 207-824-8501